Category: Publications

Protection of Conscience Project publications

Redefining the practice of medicine – Part 2

Winks and nods and euthanasia in Quebec

Re:  Bill 52: An Act respecting end-of-life care (June, 2013)

Sean Murphy*

Part 1: Bill 52 in detail

Abstract

An Act respecting end-of-life care (Bill 52) purports to establish a right to euthanasia for a certain class of patients by including it under the umbrella of “end-of-life care.” Those seeking euthanasia may not be near the end of their lives and may not be terminally ill, but they are apparently classed as “end-of-life patients” because they have chosen to end their lives.

Section 25 introduces a term not used by the medical profession, “terminal palliative sedation” (TPS). By this the Quebec government means an irreversible procedure intended to kill the patient slowly. Any patient is eligible for TPS, and a proxy can consent to it on behalf of an incompetent patient.

Section 26 permits patients to be killed quickly by “medical aid in dying”(MAD) if they are competent adult Quebec residents suffering from an incurable serious illness, in an advanced state of irreversible decline and suffering from constant and unbearable physical or psychological pain. The patient need not be terminally ill and is free to refuse effective palliative treatments.

A qualifying patient must personally make a written request for MAD “in a free and informed manner.” It must be signed in the presence of professional, who must also sign the request. The attending physician must confirm the eligibility of the patient and the free and informed nature of the request. He must verify the persistence of suffering and a continuing desire for euthanasia, speak to other members of the health care team and see that the patient is able to discuss the decision with others. However, the physician cannot advise family members unless the patient so wishes. Thus a physician may kill a patient without the knowledge of the family. Finally, the attending physician must obtain a written opinion of an independent physician confirming eligibility for euthanasia.

Only physicians may provide euthanasia (MAD), and, having done so, must “take care” of a patient until he dies. Physicians who provide TPS or MAD must report the fact to institutional authorities. They must report all euthanasia cases to the Commission on End-of-Life Care.

The Act appears to assume that the regulators will establish “clinical standards” for euthanasia but does not assign them a central role, making institutional authorities primarily responsible for it.

Canadian criminal law is not affected by the Act. It continues to apply to the killing of patients by physicians, but also to any act or omission done for that purpose, including the making and distribution of MAD guidelines and protocols.

First degree murder is defined as murder that is “planned and deliberate.” A physician who does what the Act requires will have provided excellent evidence that the killing was intentional, planned and deliberate. Conforming to the Act respecting end-of-life care would seem to increase the likelihood that a physician – and anyone counselling, aiding, abetting his act – could be charged and convicted for first degree murder, for which the punishment is life imprisonment without parole for 25 years. [Full commentary]

Redefining the practice of medicine – Part 1

Winks and nods and euthanasia in Quebec

Re:  Bill 52: An Act respecting end-of-life care (June, 2013)

Sean Murphy*

Part 1: Overview

Abstract

An Act respecting end-of-life care (Bill 52) is intended to permit physicians, in defined circumstances, to kill their patients as part of the redefined practice of medicine. However, the procedure cannot become part of medical practice in Quebec unless the medical profession itself (broadly speaking) formally accepts it as a form of health care.

The strategy of the Quebec government includes three key elements:

a) A statute that authorizes and allows the regulation of “medical aid in dying” (MAD) but does not define the term, so as to avoid conflict with the criminal law and constitutional challenges to the law;

b) Compliant medical regulators, professionals and health care authorities who are expected to define MAD to include euthanasia, thus establishing it as a legitimate aspect of health care;

c) Refusal to prosecute physicians who kill patients in accordance with MAD guidelines, thus circumventing the criminal prohibition of euthanasia.

While the federal government could, in theory, appoint and pay lawyers to act as prosecutors to enforce the criminal law, this would be especially contentious in Quebec and would involve political and practical problems. If Bill 52 passes, it seems unlikely that Quebec physicians who provide euthanasia under MAD guidelines will be prosecuted. The province formerly refused to enforce Canada’s criminal law on abortion for over twenty years, so a policy of refusing to prosecute physicians providing euthanasia could have similar staying power.

Though Bill 52 does not actually require or authorize the killing of patients, from a practical perspective, the text of the statute is a “mere technicality.” Nonetheless, it is not a mere technicality that the medical establishment and not the statute will have directed that patients can be killed in order to relieve their symptoms.

On the contrary: it is profoundly significant. Having formally approved of euthanasia, the medical establishment (meaning all of those who collaborate in drawing up MAD guidelines and protocols) will be at particular pains to defend and enforce the decision. In the end, freedom of conscience for Quebec health care workers who object to euthanasia may come to mean nothing more than the freedom to find another job, or the freedom to leave the province.  [Full commentary]

A “medical misadventure” in Ireland

Deaths of Savita & Prasa Halappanavar

Galway, Ireland: 21-28 October, 2012

Sean Murphy*

Savita Halappanavar was a 31 year old woman who was 17 weeks pregnant when she presented at the University Hospital, Galway, on 21 October, 2012, with a miscarriage.  She spontaneously delivered a stillborn daughter, Prasa, on the afternoon of 24 October, and died from sepsis early on 28 October.  The circumstances of her death generated a hurricane of controversy in Ireland and around the world about Irish abortion law.  A coroner’s inquest held in Galway in April, 2013 resulted in the classification of Savita’s death as a “medical misadventure.”

What follows is a chronological account of Savita’s care and treatment from 21 to 28 October, drawn from newspaper reports of the evidence taken at the inquest.  [Read more . . .]

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Protection of conscience initiative launched by New Zealand health care professionals

NEWS RELEASE

For immediate release

Protection of Conscience Project

The New Zealand Health Care Professionals Alliance Te Hononga Mãtanga Haurora O Aortearoa has launched a website highlighting the interest of the Alliance in freedom of conscience in health care.  The new site features a Best Practice Guide, Patient Support and Resources, and an introduction to the Alliance’s Mentorship Programme.

The Alliance is a non-denominational organization that welcomes members from all health care professions, including nurses & midwives, doctors, radiographers, pharmacists, laboratory technologists, anaesthetic technicians, and radiation therapists.  Hospital chaplains may also join.  Membership is open to professionals in training, practice and retirement who support the purposes of the organization.

Sean Murphy, Administrator of the Protection of Conscience Project, offered his congratulations to the Alliance.

“Since the Project began in 1999, it has emphasized the importance of local initiatives of this kind,” he said, “and especially the need for health care professionals to become active in support of their own fundamental freedoms.”

“The people best placed to respond to pressures against freedom of conscience in health care are those closest to the action,” Murphy explained.  “New Zealanders know best what challenges they face in their own country, and how to respond effectively to them.  The history of the Alliance demonstrates that quite clearly.”

The New Zealand Health Professionals Alliance (NZHPA) was incorporated in 2009 in response to an attempt by the Medical Council of New Zealand to suppress freedom of conscience by means of a direction called Beliefs and Medical Practice.  Relying on the Health Practitioners Competence Assurance Act 2003, the NZHPA applied to the High Court for a judicial review of the draft statement because it considered it unlawful.  The court supported the NZHPA, and the Medical Council ultimately decided not to publish the direction.

Uruguay’s Voluntary Termination of Pregnancy Act

 Protection of conscience provisions may be defined out of existence

Sean Murphy*

In the fall of 2012 the Uruguayan legislature passed the Voluntary Termination of Pregnancy Act, which legalized abortion in the country under certain circumstances.  By January, 2013, Reuters was reporting that the law was meeting “fierce opposition” among Uruguayan gynaecologists, with up to a third of them refusing to provide the procedure for reasons of conscience;1 in some locations, almost none will do so. . . Full Text